Demo version of a cost-benefit tool for contraceptive programmes
Hello, my name is Jari Kempers. I’m a health economist. With this short video, I’m going to present you a demo version of a cost-benefit tool that we have built for contraceptive programmes.
What is it?
It is an online tool that models health outcomes, and it compares the investment needed with the potential cost savings. And so, therefore, it is a cost-benefit analysis.
But more importantly, it is an advocacy and presentation tool. And it is used together with an investment case. So say, a three four-page document that you hand out to your counterparts in the meetings with the concrete recommendations and short to the point information. In essence, it is advocacy, supported by health economics.
In essence, it is advocacy, supported by health economics.
You want to convince the decision-makers that the contraceptives are a good cost-saving investment.
First of all, experienced health economists are in short supply. And then finally you find one, and you get your study done. My observation is that health economic reports and studies are often, say underutilized, or only used once when the health economist is there and presents the work. And then it is not used anymore. So it’s not a very effective way of using these types of studies. And also, my observation is that the medical personnel are often not comfortable reusing or presenting these studies.
That’s why we started thinking about how we could help? How health economics work could be used more effectively and longer? That’s why we both built this online tool. And we paid special attention, and we limited the number of inputs that the user needs to use. And also, we made a kind of build-up on how the results are presented. So in a minute, I’ll show you the tool itself.
For whom it is?
The target audience, they are healthcare policymakers, the Ministry of Health, in some countries health insurance or the Ministry of Finance people. And is used by international organizations or SRH experts, and in general, persons who are not health economists.
Health economics service
What we offer is a health economics service. We do data collection that is needed to be done in order for the model to work in your situation. We collect the data on the contraceptives, contraceptive prevalence rate (mCRP), the method mix, the policy goals and so forth. There are also health outcome data what needs to be collected and costing of the family planning services.
The cost of providing the contraceptives and also inputs needed for modelling the averted healthcare costs. We localize the model to work in your country, but what is more important is that it needs to work hand in hand with the current advocacy messages, what we are currently working on, so they are working together.
We write an investment case, a three-page policy brief, investment case for the healthcare decision-makers with the concrete recommendations and straightforward results that they can easily get quickly from the document. And then we will leave you with the online tool, we do the base case. But later, you can do your own scenarios and you can save them on the tool, say, your method mix changes or your policy goal goes up or down. And you can model then yourself the economic impacts of the changes. I’ll show you a quick introduction to the online tool. I’ll show the user set up, the inputs what you need to choose, and then I’ll show you the results and the summary. In this video, we will skip the advanced inputs to save time. Okay, let’s get started.
So here, I’m going to walk you through the model as you would be using it in your meetings. We have on purpose limited the number of the inputs that the user needs to select. You start by selecting the time horizon. Typically, the year when you have the latest contraceptive prevalence rate data, in this exercise we assume that is 2020. Then, if your country has a five-year policy call, then you choose a target for five years. If you have, say, three years left of the plan, then you can choose a shorter time horizon. Here we have five years, from 2020 to 2025.
We can put multiple countries in the tool. In this case, I’ll show Mozambique. We have here multiple countries already in. You can choose then the geographic area. Typically countries deal with the entire country, but in some countries where there is a fragmented governmental structure and the procurement of contraceptives is pushed towards the local authorities, you may want to choose a province or even a city. Just that your numbers reflect the reality of what these decision-makers are dealing with. In this case, we will look at the entire country.
Next, you can choose different populations, say all women or in-union. You can also add adolescents, different age groups, or vulnerable groups. Here one should not do overkill. One should only choose the ones that you’re currently advocating for. In this case, we will look at women in-union, 15 to 49 years old.
Contraceptive prevalence rate
The whole forecast is driven by a modern contraceptive prevalence rate (mCRP). In the setup, we will put the current method mix. Different long-acting and short-acting methods, and the current portions.
Then you have the policy goal. In this case, we are advocating for a 5% increase in the uptake. Then you put the targeted contraceptive method mix for this year. It is all done here in the setup. Then the tool shows you the current method mix, and also the population. Say, here we have all the women and this is in-union. What we are actually looking at. Then, once you have selected all these. I jump right away to the results.
This is what you would use in your meetings. So, the point here is that we want to build up the results in a way that the policymakers, who are not experts in contraceptives or family planning, can still understand this.
Here, we are advocating for a 5% increase mCRP from 35% to 40% in five years time. What would it mean in terms of family planning users? So, in-union, this would mean from 1.6 million to 2.1 million in five years time.
What does it mean then in terms of health outcomes, if you have more family planning users? There are obviously less unintended pregnancies, and because there are fewer pregnancies, you have fewer live-births and abortions. Here we get the numbers for each year, and we have numeric tables for all of them. Then, because we have fewer pregnancies, you have fewer deliveries, abortions, you have a reduction in maternal mortality. In this case, there would be 3,300 deaths averted in the beginning, and that would increase to 4,400 averted deaths per year at the end of the forecast.
Then, there are two sides of the story. You have the investment needed, and you have the cost savings caused by the contraceptive use. First, we saw that the cost of family planning services. First of all, this shows that in five years, one would need a $50 million investment. This shows where the money would be spent.
Mainly on injectables and pills, and some on condoms. This is not just the devices or pills. Here the costing, what is done as a preparation for the model. It includes then consultations, say, you have an intake consultation, you have insertion or operation, then you have a control visit, yearly control visits or removals, all these things. It also depends on who is doing these consultations. Is it a midwife, GP or specialist? They all carry different time costs. This is based on the costing study.
Averted healthcare costs
Then the other side of the story is the averted healthcare costs. Because there are less pregnancies, less antenatal care and delivery care needed. There are less complications, there are less unsafe abortion-related care needed.
We saw in the previous tab that $50 million investment was needed. And the potential savings during this period would accumulate up to $172 million. Then we bring these together. This is the investment what you are lobbying for. The potential healthcare cost savings would be $172 million.
Then these would be the net savings for the Ministry of Health. This demonstrates that contraceptives would be a very good investment for the money of the Ministry of Health. Then we bring these also together for cost-benefit analysis. We add the yearly investment needed and the potential cost savings for every year.
Obviously, this is quite a lot of information for a decision-maker. Then we want you to be able to wrap up the meeting. In the way that they remember things, and here we have this kind of cards. For the five years, you would need to invest $50 million. At the end of the forecast, 2025, you have 2.1 million users. During the whole five year period, you would avert 3.6 million unintended pregnancies. Maternal deaths would be reduced by 23,000. And potential healthcare costs savings would be $172 million. And this would mean that the return on investment would be 1 to 3. Meaning that $1 spent on the contraceptives would save you potentially $3.
Interesting for your programme?
I hope you liked the modelling tool. If this is something for your country or for your programme, please send me an email and we can schedule another call to discuss the details.